Sunday Focus: Gambling with health care

Sunday

Dec 23, 2007 at 12:01 AMDec 23, 2007 at 11:18 PM

The plastic jug between the cash registers at Sirloin Stockade bears a simple hand-written notice. It asks for spare change to help an employee named Sereta Jefferson, who was diagnosed with cervical cancer at the end of September.

Tom Loewy

The plastic jug between the cash registers at Sirloin Stockade bears a simple hand-written notice.

It asks for spare change to help an employee named Sereta Jefferson, who was diagnosed with cervical cancer at the end of September.

Jefferson’s diagnosis wasn’t the product of the check-up or regular physical. Her journey from a job in Sirloin Stockade’s bakery to chemotherapy treatments for stage-2 cancer would have never started but for a chance fall. Her lack of health care benefits, fear of the costs of regular basic check-ups and ignorance of the services available to her are common for many living in Knox County.

Jefferson occupies the very tip of the modern health care dilemma. She has worked most of her life, but never made much more than $17,000 a year. She has been on Medicaid since the birth of her first child 24 years ago, yet the 44-year-old mother of four always put necessities like food, clothing, housing and the power bill ahead of her own health.

She has not worked since the beginning of September, faces a year of treatment to battle cervical cancer and supports her 18-year-old son, George, who lives at home. She has applied for Social Security benefits.

For now, Jefferson is expected to survive the cancer. But the kind of life she will have in the coming months is in doubt. She is living on some savings, relying on help from friends and on the kindness of strangers who put change in a plastic jug.

“Until I get Social Security, I don’t know how I’ll make it,” she said. “Christmas won’t be much this year.”

Inside one life
“If I could tell people one thing, it would be to get regular check-ups,” Jefferson said as she sat on a couch in her living room. “If I hadn’t fallen, I would have never known I had cancer.

“It’s scary to think about.”

Jefferson’s problems started on July 29, when she slipped and fell while shopping.
“One leg went out one way and my other leg went back,” she said. “I wet myself and I couldn’t walk. My leg was killing me, but I took some Ibuprofen and went back to work.”
Jefferson lived with the pain for almost a month. Despite a severely swollen right leg, she missed little work. On Aug. 23 she worked a double shift, came home and discovered her right leg had swelled to twice its normal size.

Jefferson can’t purchase health insurance through her employer. Like many Public Aid recipients, she waited until unbearable pain and gnawing fear drove her to act. She went to Cottage Hospital’s emergency room on Aug. 24 and ended up staying eight days.

Doctors found blood clots in her right leg and treated the problem with blood-thinning medication. She returned home briefly in September, but ended back in the hospital for 14 days.

By the end of September, Jefferson started passing blood clots she described as “the size of my hand.”

After three hospital stays, doctors found Jefferson’s uterus was enlarged. Then they discovered she had cervical cancer.

“I’ve had one pap smear in the last 10 years,” Jefferson said. “I don’t know the last time I had a complete physical. I know it was something I always put off.

“People should know they shouldn’t put these things off.”

Watching his mother battle health problems has left her son George feeling vulnerable.
“I don’t think she is going to die,” he said. “But I do worry about the bills. How are going to make ends meet? I’ve tried to find a job, but it is hard.”

While Jefferson has gone without basic medical check-ups, all four of her children do have regular examinations. George said he will remain mindful of the importance of check-ups, even after he moves off the Medicaid coverage.

Inside the system
Those who can’t pay for health insurance through their employer, individual policies or are unemployed have two options — Medicaid or the Knox County Community Health Clinic.

Medicaid is available for adults who fall below specific monthly income levels. The program allows the patient to choose his or her own doctor and the state is billed for the services. Medicaid covers over 10,000 people in Knox County, but is unwieldy. Reimbursement to local physicians routinely takes months — sometimes as long as half a year.

Reimbursement has long been a health care issue. Getting Medicaid recipients like Jefferson to make regular visits to a physician is another daunting challenge.

“Adults who face financial difficulties often wait for an acute problem,” said Michele Fishburn, who promotes the community health clinic for the health department. “People end up waiting and hoping symptoms go away. If they get worse, they end up going to emergency rooms. One of the problems is that people on Medicaid don’t have a relationship with a doctor.”

Many other Knox County residents fall outside qualification standards for Medicaid or don’t know how to receive benefits.

“We have people who fall through the cracks,” Fishburn said. “We have people who work two or three jobs, or a couple who work multiple jobs, and don’t qualify for Medicaid but still can’t afford health care costs. Or maybe someone works for a small company that can’t offer a health plan.”

The Community Health Clinic reopened in November of last year and represents a collaborative effort by OSF St. Mary Medical Center, Galesburg Cottage Hospital, Galesburg Community and Healthcare Foundation, Galesburg Clinic and the Knox County Board of Health to fill a void left by the absence of a free clinic. The Board of Health serves as an administrative host for the clinic and it is located in the Health Department.

Shortly after its opening, Knox County Health Administrator Greg Chance said he expected the clinic to treat 3,200 patients during its first year, primarily adults 19 and older.

Preventative care options
Jefferson’s decision to delay health exams, lack of preventative care and cervical cancer could make her a poster child of recent health care measures in Illinois.

As of Oct. 1, Gov. Rod Blagojevich expanded the Illinois Breast and Cervical Cancer Program to all uninsured women in Illinois, giving them access to cancer screenings and treatment. The program estimates more than 260,000 women in Illinois will qualify for free cancer screenings and affordable treatment when they need them, regardless of income.

Uninsured women diagnosed with breast or cervical cancer will qualify for comprehensive healthcare coverage provided by Healthcare and Family Services as long as they need treatment for breast or cervical cancer. Women diagnosed with a pre-cancerous cervical cancer condition who need follow-up diagnostic tests will also qualify for HFS coverage to determine whether they actually have cancer. Healthcare coverage will include doctor visits, inpatient and outpatient hospital care, emergency services, prescription drugs and more. Women who need treatment will pay modest co-payments for doctor visits, brand name prescription drugs and inpatient stays.

Blagojevich also launched a program in July of 2006 called Illinois Health Connect — an attempt to make Medicaid recipients aware of the importance of preventative care.

Those enrolled in Illinois Health Connect will have a “medical home” through a Primary Care Provider. That single Primary Care Provider will coordinate and manage the Medicaid recipient’s care. It is also hoped that having a single Primary Care Provider will help people with chronic conditions like asthma, heart disease or diabetes get the treatment and ongoing care they need to minimize the need for hospital care. Primary Care Providers will make referrals to specialists for additional care or tests as needed.

As the battle over how to fund such ambitious health programs is fought in this state, Jefferson said people need help and made aware of the programs available to them.

“I think a lot of people assume tests and check-ups will be expensive,” she said. “I wish I knew more about what some of my options were, but the bottom line is that I needed to get checked out and I didn’t.

“But people should go. You pay a little in the short run, but it is better than the price of waiting. The long run is always more expensive.”

What is Poverty?
-The U.S. Census Bureau estimates the number of Americans in poverty with annually updated poverty thresholds. Families with income below the threshold for their family size are considered to be living in poverty.
-Eligibility for government assistance and other programs is determined by where families fall on the Federal Poverty Guidelines, the version of the poverty thresholds used for administrative purposes.